Provider Demographics
NPI:1447701651
Name:MINNELLA, GRACE ZUCCARO (MS, LAC)
Entity type:Individual
Prefix:MS
First Name:GRACE
Middle Name:ZUCCARO
Last Name:MINNELLA
Suffix:
Gender:F
Credentials:MS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 WERIMUS RD
Mailing Address - Street 2:
Mailing Address - City:WOODCLIFF LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07677-7713
Mailing Address - Country:US
Mailing Address - Phone:551-587-2287
Mailing Address - Fax:
Practice Address - Street 1:345 N MAIN ST
Practice Address - Street 2:SUITE #10
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-4305
Practice Address - Country:US
Practice Address - Phone:551-587-2287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-23
Last Update Date:2016-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002196-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist